Plenary, 20 Nov 2003

Meeting date: Thursday, November 20, 2003

Official Report 819KB pdf

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Maternity Services (Glasgow)

The final item of business today is a members' business debate on motion S2M-511, in the name of Sandra White, on the review of maternity services in Glasgow. The debate will be concluded without any question being put.

Motion debated,

That the Parliament notes the decision of Greater Glasgow Health Board to endorse the recommendations of the maternity working group to close the Queen Mother's Hospital and transfer services to the Southern General Hospital; further notes the concerns of the public and hospital health professionals at the closure of the Queen Mother's Hospital and subsequently services at the Royal Hospital for Sick Children and the adverse effect that this will have on maternity and children's services throughout Scotland, and considers that the Minister for Health and Community Care, Malcolm Chisholm, should launch an immediate investigation into the maternity services review by Greater Glasgow Health Board.

I thank all the MSPs who signed my motion. I pay special tribute to the Glasgow Evening Times, which has been at the forefront of the campaign for maternity services in Glasgow. Not only was it responsible for a petition that has been running for many weeks, but it has kept the general public well informed of all aspects of the maternity services review—something that Greater Glasgow NHS Board failed miserably to do.

I make it clear that this is neither a party-political issue nor solely a Glasgow issue. The closure of the Queen Mother's hospital, with its unique position in the Yorkhill complex, will have an adverse effect on all maternity services in Scotland. I am pleased that MSPs from all over Scotland have stayed behind to take part in the debate.

It is beyond belief that this world-renowned set-up is in any way under threat. It is a state-of-the-art provision that many countries want to emulate, but Greater Glasgow NHS Board is trying to destroy it. On a recent visit to the Queen Mum's, I met young doctors and other professionals who told me that they had chosen to train and work at the Queen Mum's because it was a world leader in innovation and practical medical advances that exist nowhere else in Scotland.

I apologise to Sandra White for the fact that I cannot stay for the whole debate. Does she share my concerns about reports suggesting that the hospital's breast-feeding support unit may be forced to close its life-saving breast milk bank if the Queen Mum's closes? Does she agree that action must be taken to ensure that that vital service is not put in jeopardy?

I agree entirely and have supported Elaine Smith's motion to that effect.

Like my colleague, I may have to leave before speaking in the debate. I apologise for that. Ironically, I am going to a meeting in my constituency about school closure proposals caused by the falling birth rate.

Does the member agree that the issue of expertise is not about buildings, but about the people who have it, and that the discussion surrounding the Queen Mother's hospital has consequences for the Southern general hospital on the south side of Glasgow, or does she intend to argue that we need three centres in Glasgow?

I thank Johann Lamont for her intervention and am sorry that she cannot stay for the rest of the debate. However, I am pleased that she has at least arrived for it.

Johann Lamont is right to say that this debate is not about buildings. On a recent visit to the Queen Mum's, the professors told us that the issue was not buildings, but the unique set-up that keeps mothers and babies together. Greater Glasgow NHS Board has forgotten that.

I mentioned the Yorkhill complex, which houses both the Queen Mum's and the sick kids hospital and has been at the forefront of pioneering techniques. I know that other members want to comment on that point. I refer to techniques such as foetal diagnosis and therapy; Professor Ian Donald also pioneered ultrasound for maternity services at Yorkhill. Professionals are seriously concerned that if the Queen Mum's closes the experience and expertise that both hospitals have built up will be lost.

The support that other medical professionals throughout Scotland and beyond have given to their colleagues at the Queen Mum's is a sign that the campaign to avoid closure is not just a knee-jerk reaction to a local inconvenience—it is a Scotland-wide campaign. Today I received a phone call from a campaigner who told me that he has written to the Queen on this issue. She has written back to him to say that she has contacted Dr John Reid. If the minister is not already au fait with that, perhaps he should contact Dr John Reid MP, who might intervene on the campaign's behalf if the Executive does not wish to do so.

I turn my attention to the consultation process, which is the nub of the issue. From the beginning the consultation process was flawed to the point of being a sham. If, as some people are saying, that is not the case, why was the Royal College of Paediatrics and Child Health not invited to contribute? What about the concerns of paediatric cardiologists at Yorkhill, who have had to write to the newspapers to get over their information about the 60 newborn babies with serious heart disease who have been treated in the sick children's hospital in the past year? Why were the views of child psychiatrists not noted? Experts such as Alice McGrath and Michael Morton have stated:

"We do not believe the way forward involves the closure of a specialist centre that allows sick babies and their mothers to be together as much as possible".

Recently I attended a public meeting where emotions were running very high. The two most telling contributions came from health professionals who were pleading the case for the Queen Mother's hospital. One of those professionals, Anthea Dixon, spoke of the special relationship that helps to make the Yorkhill site world renowned for the care of babies and children. She expressed her concerns that she had not received a copy of the consultation evidence from the health board. I have not received a copy, either, even after repeated requests.

Professor Cockburn, who is highly thought of, spoke with real emotion about the work that is carried out at the Queen Mother's hospital, much of which would be disrupted if closure went ahead. He was truly angered that his evidence and that of many other eminent health professionals was not included in the consultation document. As well as all those experts who were ignored in the so-called consultation, there have been approximately 100,000 signatures on a petition from concerned citizens all over Scotland and beyond. Although Catriona Renfrew of the Greater Glasgow NHS Board has arrogantly announced that public opinion will not influence the closure decision at all, we politicians cannot afford to behave in such a high-handed manner. There is real anger among the public, and the minister must look into the issue immediately.

I apologise to Sandra White but I have to leave the debate early because I have an engagement with Unison.

I ask Sandra White to comment on a few points. She referred to specialist services. Does she agree that professionals in the area are concerned that extracorporeal membrane oxygenation—ECMO—will cease to be available in Glasgow if the Queen Mother's hospital closes? Does she agree that there need to be three units in Glasgow and that that is the only sensible solution? Does she agree that it is absolutely shocking that there has been no assessment of the cross-boundary impact of the maternity strategy, contrary to Executive policy on regional planning?

I am pleased that Carolyn Leckie has stayed until now.

Some of my colleagues are going to pick up on some of the questions that Carolyn Leckie asked, particularly about ECMO and the situation with the Southern general hospital. The professionals are concerned that the professionalism and expertise at Yorkhill could be lost to Scotland.

There is real anger about the proposals and the minister would do well to speak to the publicly appointed board and tell it that it is there to serve the public, not to dictate to us. People are very angry and unhappy about the whole situation. We all know that the health board is a publicly appointed body, and secrecy is not necessary in this case; secrecy is very much against the public interest. Misinformation is also unacceptable and the health board's suggestion that there are no high-dependency beds in Yorkhill is an untruth. There are high-dependency beds on the Queen Mother's hospital site and people should remember that. Sometimes, people have to be moved from the Southern general hospital because there are no beds, so it is a fallacy to say that there are no high-dependency beds at Yorkhill.

The specialist and dedicated staff of the two units are pleading with the minister and others to look into the situation now and to start an investigation. I ask the minister to remember his find words about "a culture of care" and

"a new partnership between patients, staff and Government."

Those fine words should now be put into action. Nothing further should happen until the minister puts together an investigation of the consultation. We want to know how the evidence was gathered, and if the evidence gatherers and the pre-emptive decision that was taken by the working group to close the Queen Mother's hospital were acceptable. I demand that that investigation takes place immediately.

I ask members to keep speeches tight and nearer to three minutes than four, if possible.

I am grateful to the Presiding Officer for taking me next. I again apologise for not being able to stay until the very end of the debate.

I acknowledge that views on this issue are not split along party-political lines and that some of my colleagues take a different view from me. Equally, I have to say that some of my colleagues have not taken a fully-formed view on the matter. I thought that it was important to make some points that perhaps have not been given the same airing as others and to bring some balance to the debate.

I also acknowledge that this is a very emotional matter that causes some concern. Clear, authoritative and professional voices have expressed views on all sides of the debate, and we are in the difficult position of hearing different professionals' opinions on the same issue—opinions that profoundly disagree with one another. However, unlike Greater Glasgow NHS Board, we also have the luxury of not having to square many circles.

We have to confront the issue. If we keep the Queen Mother's hospital open, we have to close the Southern general hospital. Such a decision is not a free one; it will have consequences elsewhere. There is also a genuine concern that we need two maternity centres. However, even if we had all the money in the world, we should not tie up our increased funding for the health service in keeping wards closed. We must ensure that every penny we put into the health service addresses health needs.

If we are going to have more than two centres, how many more will we have? If the issue is all about locality and access, how many more centres do we need? What should the provision be in other parts of Scotland?

Will the member give way?

I will let the member in soon.

I had my own children in Rutherglen maternity hospital and was deeply distressed when I heard that it was closing. However, I was even more distressed later on in life when a professional informed me of the risks I was taking in giving birth in a free-standing maternity unit. As a result, I now understand that there is not necessarily a connection between one's emotional feeling about a place and the reality of the medical advice that one receives.

At the centre of this debate is the requirement to balance the needs of women and babies. I have been told that although women who fall ill in childbirth require immediate attention, neonatal babies are not operated on within the first day. As a result, the issues of travelling or of where care should be provided are slightly different in such cases.

Is the member aware of comments by consultants in Edinburgh that the fact that the new Edinburgh royal infirmary is further away from the sick kids hospital than the old ERI is a major disadvantage? They have recommended that Glasgow should learn lessons from what has happened in Edinburgh.

I understand that. As I have said already, I appreciate that many voices out there that are raising difficult points that we have to listen to.

Provision by the sick children's hospital is Scotland-wide. The logical conclusion of the argument that the Queen Mother's hospital must be beside the sick children's hospital is that everyone should have their children in the Queen Mother's hospital. If the provision is Scotland-wide, it is only natural that people will have to travel to use it.

Will the member give way?

Will the member give way?

Members should let me make progress for a minute.

If the ideal position is that all services should be located on one site, the Southern general hospital is logically the only site that allows for a long-term solution.

I think that, as in the debate on the acute services review, it is unhelpful to focus on buildings instead of on real health needs. Everyone knows that the issue is not about cost-cutting, but about using moneys to address health inequalities. For example, we need to maximise the amount of money that is allocated to vulnerable women, women with drug problems and so on. Such women do not have healthy living conditions and might not even be able to access antenatal care or the care that they need to support their children once they are born. Indeed, those children are sometimes at their safest when they are born. We need to find services that address the needs of those mothers and their children before and after birth. As a result, I seek reassurance from Greater Glasgow NHS Board that it is accessing money for genuine community provision and antenatal and postnatal care, because those services will most benefit the vulnerable women in my community.

Although I acknowledge the point about centres of excellence, I return to my point that excellence and expertise are about people and funding, not about sites. The sites are random; instead, we have to ensure that provision exists across the service.

I congratulate Sandra White on securing this important debate and on the measured and informed way in which she introduced the topic. I should begin by saying that I am here principally to speak for Bill Aitken who this week had a second accident and is currently in Glasgow royal infirmary. He would have wished his views to be expressed on this matter, although communication with him has understandably not been possible this week.

Bill Aitken is concerned that we risk disrupting and possibly losing some of the quality that exists in the present centre of excellence. He is concerned about some of the cross-river transport issues that are similar to those raised in connection with the acute services review. He is also concerned about some of the long-term implications that arise from the uncertainty about what further changes there might be regarding the sick children's hospital.

The issues that are raised in the consultation impact particularly on greater Glasgow, which means that they spill into the West of Scotland region. I want to address those less immediate implications for the west of Scotland that arise from the current use of the Queen Mother's hospital as the principal point where patients from the Vale of Leven catchment area require to go for maternity services because of the closure of the consultant-led service at the Vale of Leven hospital.

Yesterday evening I attended a large public meeting in Dumbarton—one of a series of such meetings—in which considerable misgivings, to put it most moderately, were expressed by the local public. It is more accurate to say that there is deep discontent not only about the loss of acute services at the Vale of Leven hospital, but about the impact of the loss of services on the maternity side. There has been recent considerable concern about what appears to be a sharp increase in births taking place in ambulances as a result of the greater distances that require to be travelled as a consequence of the rationalisation of services. In the brief time that I have had this week to pursue the topic, it seems remarkably difficult to get statistics on those issues.

It is unfortunate that Johann Lamont did not take an intervention from me, but she suggested that neonatal transfer was somehow an option that was available nationally. What she omitted to mention is that, because of the existence of the Queen Mother's hospital at the Yorkhill site, the preferred option of every obstetrician that I encountered in my professional life was to transfer babies in utero to the Queen Mother's hospital so that they could get immediate treatment. That is the preferred clinical option and I wonder whether the member will comment on how, suddenly, some clinicians think that it is okay to embark on the risky business of transferring neonates when that should not be required.

The member will understand that I am not prepared to answer for clinicians who have put that contrary point of view, because that is their point of view. The member will have to pursue that with them. She has put her point on the record and the minister might wish to reflect on it.

What comes across from the members of the public with whom I am in contact is a complete lack of information from any rational, national debate about what has been, over the lifetime of the Parliament, a series of localised rationalisations, reductions and mergers throughout Scotland. There been no national strategy. Above all, there has been no spatial dimension, in the sense that no one has said, "We need centres here, here and here." As Duncan McNeil recently pointed out forcefully, the process in the west of Scotland is driven by two different health boards for a national health service that is concentrating all the provision for the west of Scotland in two hospitals that are five minutes apart—the Royal Alexandria hospital and the Southern general hospital. One might say that there is not much difference between the Southern general and the Yorkhill sites in relation to the big picture, but the crucial difference is that both the Royal Alexandria and the Southern general are on the south side of the Clyde. The Queen Mother's hospital at Yorkhill is on different transport routes, which means that the existing Glasgow sites together provide a much better service than we will have if there is a rationalisation in Glasgow that puts all provision on the south side of the river.

Ministers have to convince the public that there is a genuine national strategy that will reflect and satisfy local needs. They have to recognise that they are losing the battle to convince the public that that is a priority of the Executive.

Sandra White has initiated an important debate on the future of maternity services in Glasgow. We have all been through many campaigns on these issues: I was involved in the campaign against the closure of Rutherglen maternity hospital, to which Johann Lamont referred, where my children were born.

We have to disentangle the related issues in the maternity services review in a way that reflects the genuine issues, irrespective of whether that is how it has been phrased by the health board in its consultation arrangements.

With the decision to reduce from three to two the number of maternity hospitals in the city already taken, the first question is whether that was a correct decision. One significant issue is capacity. The falling birth rate is such that the current and likely demand from greater Glasgow can be accommodated in two hospitals. Given the huge demands on health services in Glasgow, the price of retaining three hospitals would be significantly less money for other key health services and a stretching of health resources too thinly.

Greater Glasgow NHS Board says that such pressures mean that it is no longer possible to keep three maternity hospitals open safely. We have to be careful not to waste scarce health service resources. The issue for the minister is whether the changes in maternity provision in surrounding areas, such as Renfrewshire and Dunbartonshire, change the demand and staff figures significantly for Glasgow.

The second issue is the location of the second maternity hospital, other than the Princess Royal. Location is always emotive, but I will make a couple of observations. First, if the maternity facilities at the Southern general were to go—which is the alternative—there would be no maternity facilities on the whole of the south side of Glasgow. My second observation relates to the Clyde tunnel. Much has been made of the problem that would arise if the Queen Mother's hospital closed and there was a blockage in the Clyde tunnel. That is undoubtedly an issue, but the Clyde tunnel is not a one-way tunnel, so that argument points both ways: it would apply in equal measure if the Southern general maternity provision were chosen for closure.

The third issue is the important link between the maternity facilities at the Queen Mother's hospital and the paediatric facilities at the Royal hospital for sick children, which has been touched on already as a major point of the debate. Maternity specialists seem to favour the link with an adult hospital on the basis that it will save maternal lives, and some eminent specialists on the paediatric side have expressed strong views about dangers to children if the services are separated. From that, the best medical conclusion must be that maternity and paediatric facilities should be co-located on an adult acute site which, oddly enough, was the health board's original plan when it produced the acute services review to which we all objected in the previous session.

I am not convinced that the health board has yet got this right. We are perhaps trying to do too many things too quickly. Major changes are due to take place at the Southern general as a result of the acute services review, and we are only just beginning the provision of the ambulatory care and diagnostic units. Maternity provision across Scotland is in uproar, with major reductions in the number of specialist maternity units. Would it not be better to approve some of the other changes in maternity provision that reflect the way expert opinion is going—such as the move to more midwife-led deliveries, developing the quality of specialist services, and all the rest—and retain the present three sites in some form for a slightly longer period?

I concern myself with the health resource issue that comes out of that, but the central priority is to keep the vital link between maternity and paediatric services. It is less important that they be located at Yorkhill. The health board should go back to the drawing board and come back with new proposals and a consultation that directs itself at that central issue, which I do not think the current proposals do.

I congratulate Sandra White on securing this debate. I will try to be as brief as possible.

Greater Glasgow NHS Board should rethink the issue. I have absolutely no doubt that the Queen Mother's hospital and Yorkhill are married together and should stay together. They have saved lives. Why is that? Because they have worked in teams. Wonderful teams have been built up over years. Greater Glasgow NHS Board has the great idea that when something is good it ought to break it up, but if we have something that works, we should keep it and build on it. People leave teams and people join teams, but they learn from the experience that grows within a medical team, therefore that team—Queen Mother's and Yorkhill—should stay together.

I will give the chamber another example. People come from all over. Carolyn Leckie was right to say that if someone thinks there will be a difficulty with a delivery, they get the mother there with the baby inside her, because then there is a more controlled outlook for mother and baby to survive. My sister-in-law and niece are alive today because of that connection. Many of my constituents have emphasised that and many other people say the same thing.

Another way of explaining it might be to say that specialist teams do not need to be in every town or area. The neurosurgical unit at the Southern general works well. People know where it is and it is accepted that medical services are provided there. It used to be that neurosurgeons went round hospitals. Obstetricians and gynaecologists could do the same thing.

I ask the minister to think carefully about locating another huge unit at the Southern general. The Greater Glasgow NHS Board plan means that, by the time he is finished, we will have the biggest megahospital on the south side of Glasgow, and I wonder what that will do to traffic jams. It is not the best location for a general hospital, and I hope that the minister will find it in his heart to fund acute beds at both ACADs.

I am in the Parliament because consultation with the public has not been good. People do not think that the authorities listen. They may consult, but consultation is no good unless the people doing the consulting hear. I do not think that Greater Glasgow NHS Board or the politicians are hearing. I have said to Malcolm Chisholm on other occasions that, after 18 years of Conservative Government, the Labour Party could have been in power for life if it had got the consultation right. It is political suicide not to listen to the public and the clinicians who work in the hospitals. It disturbs me greatly that Catriona Renfrew can say that a million signatures will not change her mind, because we have previously had dealings with her in relation to Stobhill.

I urge the minister to pay attention. The health service in Glasgow and the west of Scotland—and probably throughout Scotland—is about to fall apart because nobody seems to be doing the joined-up thinking. That scares me and it scares my colleagues. I speak for many clinicians in this matter: the maternity hospital and Yorkhill should not be separated—absolutely not. It would even be possible to have a maternity facility on the south side of the city, but why would the minister want to break up a world-renowned unit? At Stobhill, we have one of the most fantastic cardiac units, and the minister wants to split that up too. I cannot understand the thinking and I urge him to rethink his plans.

I too thank Sandra White for initiating the debate, which is important. I will address two issues. The first is what I consider to be the sham of Greater Glasgow NHS Board's consultation. The board is effectively asking people to choose between the Queen Mother's hospital and the Southern general. It might have decided that the retention of three maternity units is not a viable option but, to be frank, others are not yet convinced. The birth rate is falling, but when people consider developments in Argyll and Clyde and the efforts to repopulate the city of Glasgow they question the health board's certainty. At the very least, that issue should have been tested in the consultation. The fact that it will not be tested in the consultation suggests that the health board already knows what it wants—which is not the way to build public confidence in the process.

The second issue is the national, not only Glasgow-wide, importance of the Queen Mother's hospital. We are talking about it as a maternity unit, but it is not only a maternity unit: it is much more than that. With the sick kids hospital on the Yorkhill site, the Queen Mother's hospital provides a highly specialist service for very ill babies. The co-location of foetal medicine, neonatal intensive care and paediatric surgery is the jewel in the crown of maternity provision in Scotland, and losing it would be insanity. To Johann Lamont, who had to leave, I say that it is possible to argue that bricks and mortar or the site's physical location are unimportant, but it is not possible to argue that the co-location of the services that the sick kids hospital and Queen Mother's hospital provide is not vital. That co-location is what we stand to lose if the Queen Mother's hospital is lost.

The best way to illustrate the value of the service that is provided at the Queen Mother's hospital is to compare what happens to a sick baby now with what will happen if the Queen Mother's hospital goes. Currently, as Carolyn Leckie said, if problems are identified antenatally in any part of Scotland, the chances are that the mother will be transferred to give birth at the Queen Mother's hospital. When the baby is born, it will go to neonatal intensive care, where the consultants, in conjunction with the paediatric surgeon at the sick kids hospital, will assess and prepare that baby for surgery.

When the baby is ready for surgery, it goes next door to the sick kids hospital. The baby's mother is on site with it during that process. If the Queen Mother's is taken away, a sick baby in, say, Dundee, will be born at Ninewells hospital. The paediatric surgeon from Yorkhill will not be on site to assess that baby. When the baby is ready for surgery, it will go to Glasgow, but the mother will have to stay in Dundee, because no bed will be available for her at Yorkhill. I defy anybody to argue that that is an improvement in service. Rather, it represents a huge step backwards.

The counter-argument is that the Queen Mother's is unsafe for mothers because it has no adult intensive care on site. I agree that, in an ideal world, adult intensive care would be on site, but when the mother and not the baby is deemed to be at risk, arrangements are made for the mother to give birth at a hospital that has adult provision. When complications are unexpected, obstetricians are qualified to stabilise the mother until she is transferred to an intensive care unit. It is instructive to consider that, last year, only five mothers were transferred from the Queen Mother's to another hospital, and all returned within 24 hours.

The integrated world-class service that we have at Yorkhill is too important to lose. I hope that ministers will take heed of that.

I welcome the debate, which Sandra White secured. The subject is dear to my heart, as the Queen Mother's maternity hospital is in my constituency.

I will nail some of the myths. First, the Queen Mother's maternity hospital provides a national service, although it also happens to be the local service for many of my constituents. The hospital is the national centre for cystic fibrosis testing and for amniocentesis. I could go on and on. We must nail the myth about the service that is offered. It is not a run-of-the-mill maternity hospital that happens to be linked to the children's hospital; it offers a national service. That is important for the whole of Scotland.

The assumptions that have been made about the delivery of service at the Queen Mother's are fundamentally wrong. I want the minister to note the feelings of local clinicians in the hospital. How can we make a fair decision about what is right for Glasgow if the basic assumptions are incorrect?

I say that because I listened to clinicians give their evidence during the consultation process and I share Sandra White's view that the process was dangerously flawed. I listened to Professor Cockburn, who is a professor of child health, and to Tom Turner, who is head of the neonatal service at the Queen Mother's, deliver their evidence to Margaret Reid's working group. In my opinion and that of many others, their evidence was not listened to. I heard paediatricians say that if they were not allowed to deliver babies with a problem at the Queen Mother's, babies would die. The group did not ask those clinicians a question. That seriously upset me on the day and it seriously upsets me now.

Experts were appointed to advise Margaret Reid's group. It is important to understand that the debate is not about one profession versus another. Of course professions have different views, but the view of the experts who run the service was ignored. The evidence of experts from England and Wales who have no experience of running the Queen Mother's or Yorkhill children's hospital was taken as category A evidence, while the evidence from those who run the service was taken as category B evidence. Ministers must note the upset of the people who run the services at the Queen Mother's and Yorkhill about the way in which the process operated.

The Queen Mother's was never asked whether it could provide a blood transfusion service, which it does. It also delivers the fastest service. It was also never asked whether it could provide radiology intervention, by which the panel seemed so impressed. Those issues make the whole process unfair.

I disagreed with some of what Johann Lamont said, but she was right that the focus should not be on mothers versus babies. I am alarmed at the letters to The Herald that talk about what is best for mothers and what is best for babies. I am certain about the history of the Queen Mother's. As Carolyn Leckie and Nicola Sturgeon were right to say, the Queen Mother's has provided the key service in Glasgow for difficult births. It has a safe history.

If the implication is that the Queen Mother's is unsafe, I must ask why it is delivering babies now. Will we stop that service now? The health board talks about a safe, sustainable maternity service, but it does not use the emotive word "safe" in relation to acute services.

I do not see any evidence that the national services division has responded, and it is crucial to the whole process. The important thing about the link is this: sometimes, when a baby has a complication on birth, two or three specialists are required to come from Yorkhill to the neonatal unit at the Queen Mother's. What do we suggest should happen if a mother has to deliver her baby at another unit? Have those three specialists to travel round Glasgow? We can see the practical implications of that but the report does not address it. This is a national service and it will be lost to Scotland for ever. I plead with the minister not to do to Scotland what is proposed.

I am prepared, with the minister's agreement, to consider a motion without notice to continue this debate until 6.15 pm. Is it agreed that a motion without notice be moved?

Members indicated agreement.

Motion moved,

That Parliament agrees that Members' Business on 20 November 2003 be extended by 15 minutes.—[Murray Tosh.]

Motion agreed to.

I have to say that, even so, I expect only constituency and regional members to be called.

I shall be as brief as possible so as to allow others to speak. It may not be possible, but it would be helpful, if members representing areas outwith Glasgow were able to speak, particularly if their areas are affected by the closure of maternity services.

We are facing a national reduction in services that, quite simply, is not being planned for. There is no co-ordination whatsoever. I spoke to the Minister for Health and Community Care during question time a number of weeks ago when he talked about looking for a detailed service plan for the Argyll and Clyde NHS Board and Greater Glasgow NHS Board areas in relation to the delivery of maternity services. We are in the middle of decisions and discussions on services that are affected by that detailed service plan, which the minister will not even have on his desk until March. That is why the matter has united members across the political spectrum.

I welcome Sandra White's introducing the motion for debate. Robert Brown and I often disagree on political issues, but all the political parties in Glasgow that are represented on the list, and most of the politicians in Glasgow—certainly the ones from whom I have heard—are united on the question. We face the potential destruction of a world-renowned and valued service. My worry is that we could allow ourselves to be boxed into a corner where the situation is portrayed, as Pauline McNeill said, as involving a decision between the benefit of the mother and the benefit of the child—whether the Southern general's maternity services must go or whether we retain the Queen Mother's hospital linked to Yorkhill.

We must say that we do not accept that premise. Why cannot we retain the service at the Southern and the service at the Queen Mother's? The British Medical Association, which provided quite an instructive briefing for today's debate, said:

"It is important to state that it would be our aspiration for the NHS to be resourced and able to provide all services to all patients in their local communities. However, given the pressures facing our National Health Service, this is still only an aspiration and the time has come to face up to reality."

When Johann Lamont says that the decision is not driven by cost, she is wrong. If we wanted to deliver those services in the way that people want them to be delivered, we would retain the Southern general maternity service and the Queen Mother's hospital, linked to the Yorkhill service.

That is the point of view from which the minister is hearing the appeal, and it is a cross-party appeal. This is not a party-political issue at all. The minister is hearing appeals not to break up an excellent service and he is hearing appeals that it is time to say, "Wait a minute," in relation to the reduction of maternity services throughout Scotland. We must wait a minute until we have a co-ordinated plan and a co-ordinated attitude throughout the country. What is happening just now, particularly in the west of Scotland, is quite simply not acceptable.

I do not want to make a big issue of what Murray Tosh said, but the Royal Alexandria hospital and the Southern general are not five minutes apart. They are a lot further apart than that. The idea that we can have a reduction in service in the Argyll area and expect Glasgow to deal with it somehow or other at the Southern is just not on. Jean Turner made a point about the super-hospital that is beginning to develop at the Southern—it must be the biggest hospital in the world, never mind the biggest hospital in Britain. Because of the reduction in acute services, extra building will be taking place at the Southern general. Now, according to the new plan, we will have all the maternity services at the Southern general. The way that things are going, soon there will be only one hospital to serve the whole of the west of Scotland.

The proposal is simply not practical and I say to the minister that it is time to call a halt to it. In the view of the people of Glasgow, Greater Glasgow NHS Board has lost all credibility and the minister will also lose credibility if he does not step in and not allow the decision to be taken.

I join others in condemning the comments that have been made by the Greater Glasgow NHS Board official. When an official says that the number of petitions that have been received does not matter and that proposals will be proceeded with regardless of the number of petitions that have been received, that threatens our democracy. I ask the minister to deal with that matter.

It is important that all members of the public are given the opportunity to express their views in consultation exercises. As Pauline McNeill and Sandra White said, there are concerns about consultation exercises. I believe that they are cosmetic exercises. We see documents that say things like, "Have your say" and "Tell us what you think." However, the people who produce those documents want to know what people think only if it is the same as what they think. The Parliament faces a serious challenge in ensuring that, when people express their views about the future of their health service, consideration is given to ways in which those views can be accommodated. All views cannot be accommodated, because people sometimes make unreasonable demands—as an elected member, I appreciate that. However, we must develop proposals to ensure that a mechanism exists for occasions when health boards get things wrong, which happens often. That is why I plead again with the minister to consider my member's bill, which proposes opportunities for communities to appeal if they are concerned that an exercise has not been conducted properly.

Does the member agree that we are not just highlighting Glasgow issues this evening, but discussing a national situation? Does he agree that it would be better if the minister simply called a moratorium on any proposed changes in health board areas until we have had full and proper discussion of the proposals, because the issue is of national importance?

Obviously, David Davidson can raise that matter with the minister.

We must move consultation forward. We face challenges and difficult decisions in our everyday lives. If somebody asked me to move from the Clydesdale Bank to Lloyds TSB, I would want to know what improvements in service there would be. However, with the maternity services review, no one has said where patients can expect improvements in services. Every day, the health board faces the serious challenge of telling its patients where they can expect to see improvements in services and whether those improvements will be to the fabric of the buildings in which services are delivered, or to staff conditions for those who work in the buildings, or to the waiting times for maternity services.

The daily challenge that health boards face is not in asking for people's say and for what they think, but in demonstrating to members of the public where they can expect improvements to be made in services as a result of reducing three sites to two sites, for example. There has been no demonstration of how such services will be improved, because the health board in question does not know how they will be improved. All that the health board sees is a proposal to reduce the number of sites from three to two. Where members of the public can expect to see improvements in service has not been demonstrated.

I, too, thank Sandra White for giving us an opportunity to debate the issue. I was pleased to add my name in support of the motion and I am pleased to have the chance to speak to it. I was also happy to add my name to the Evening Times petition, to which many members have referred. Some 100,000 people signed it, which is even more than attended the historic anti-war demonstration in February. Those are two nails in the coffin of apathy.

None of us would try to pretend that the issues involved are simple—they are complex—but if there were rock-solid reasons for moving services from the Queen Mother's hospital and if we were certain that patient care would be improved as a result, it would be wrong to rail against closure of the hospital out of affection. However, the reasons for closure are far from rock solid. We have heard conflicting argument from the experts. In the six months or so that I have been a member, I have seen that most MSPs are hard working and well informed, but we are not the experts in delivering services—the people who do the work are the experts. Johann Lamont and Pauline McNeill both recognised that, although it is interesting that two members started from that first principle and reached different conclusions. If there is little clarity in the debate among us and among the experts, and overwhelming popular opinion on the issue, it is difficult to understand how the Greater Glasgow NHS Board reached a conclusion.

I attended a public meeting of the board. If there were strong arguments against the proposal, I was deaf to them because I did not hear them mentioned at that meeting. I fear that the board did not consider those arguments properly.

It has come to light recently that one of the four panel members did not actually go on the visit to the Queen Mother's hospital during the review process. I am concerned about that. Does Patrick Harvie have similar concerns?

I am sorry, I did not hear that question and I want to move on because I have little time.

Someone who has made his views known is the regional director of neonatal transport services, who said that the proposed system "will undoubtedly be inferior". He continued:

"To dismantle the combined neonatal and surgical service and replace that with the bed and breakfast approach is simply appalling and will lead to increased risk."

With that background of doubt about the proposals, Sandra White's motion asks only for the minister to review the decision and to ask how the board managed to reach its conclusion so clearly. If the health ministers, both of whom are here, can answer that question with 100 per cent confidence, so be it, but I do not see how they can do so. If they cannot, the call for a review of the decision is entirely appropriate. If minds are closed to that call, consultation genuinely is, as Nicola Sturgeon said, a sham.

I call Jackie Baillie, to be followed by the minister.

Thank you for allowing me to speak, Presiding Officer. I am not a Glasgow member, but a wider interest is involved and the level of concern about the issue among members is evident.

I say at the outset that I do not believe that the closure of the Queen Mother's hospital is the best option for the care of babies and their families north of the River Clyde. As others have said, the issue is not only about provision for babies and mothers from Glasgow or even the west of Scotland; it is about a resource for the whole of Scotland. The proximity of the Queen Mother's hospital to Yorkhill is a unique situation and I will not rehearse again the arguments about those hospitals being at the cutting edge of research and practice or about the consultation process, although I associate myself with the remarks of my colleague Paul Martin on the issue.

There are genuine concerns and a recognition that the debate is about the services that are in place not only for mothers, but for babies. We should have the debate, but it must be open and honest. Everybody understands the desire to avoid maternal deaths, but that must be balanced by an understanding of the desire to avoid the death of babies.

I will talk about the wider geographical context of the issue. We must consider what is going on in the neighbouring Argyll and Clyde NHS Board area. Following its maternity services review, the board concluded that there should be one consultant-led service—at the Royal Alexandra hospital in Paisley—with midwife-led units elsewhere, including one at the Vale of Leven hospital. I welcome the presence of a midwife-led unit at the Vale of Leven because it means that finally, after an absence of a year, babies are again being born locally.

I have no problem with the principle that the best possible service should be available for women and their children. For that to happen, we need to make decisions about where those services should be located. We must strike a balance and enable easy access.

I say to the minister—as I have said many times before—that, if the proposals are carried through, mothers in Argyll and Clyde would have to attend a consultant-led unit in Paisley. If a mother was discharged but there was, regrettably, something wrong with her child so that it had to be kept in the special care unit, that mother would have to undertake a five-hour return journey by public transport to bond with her child. That is not acceptable in rural Scotland, never mind in urban Scotland.

Moreover, what happens when those women have to cross the river but the Erskine bridge and the Clyde tunnel are closed at the same time, as has happened before? Our natural transport corridors north of the river run into the north of Glasgow; they do not cross the river. The minister cannot ignore the proximity of the Southern general hospital to the RAH: they are a mere 7 miles apart. The proposals do not effectively balance the need for quality with the need for access.

I very much welcome the minister's intervention in asking Greater Glasgow NHS Board and Argyll and Clyde NHS Board to work together to arrive at a much more reasonable solution and report to him in April. However, I ask him to reflect further on how we organise maternity services across health board boundaries. In doing so, he must recognise the fact that the Queen Mother's hospital and Yorkhill serve a population far greater than that of north Glasgow. His decision matters to women not just in Glasgow, but in Dumbarton, the Vale of Leven, Helensburgh and beyond.

I thank Sandra White for securing this important debate. I will respond to some of the points that have been raised, but it would be inappropriate for me to discuss the detail of the proposal, which is currently the subject of public consultation. At the end of the consultation period, the NHS board will submit its final proposals to me and I will have to come to a view then. It would, therefore, be wrong—and procedurally impossible—for me to express a clear view today. I can, however, explain what I will consider when the proposals are put to me next year. I will need to consider two issues: the adequacy of the public consultation and the substantive proposal—in particular, the consistency of the proposed reorganisation of maternity services in Glasgow with national policy.

In consulting on the proposals, the NHS board is required to follow the draft guidance that was issued in May 2002. That guidance will be reissued in its final form soon. The principles underpinning consultation are that end-process consultation is not acceptable; that boards should develop proposals for change in partnership with all the affected groups and communities; and that boards should formally consult on the outcome of that development process. To underline further the importance of consultation and public involvement, the National Health Service Reform (Scotland) Bill will place a duty directly on boards to secure public involvement in planning and development and decisions affecting the operation of health services. I am sure that the points that Paul Martin raised will be discussed in the context of that bill.

I assure Parliament that I will pay close attention to the substantive arguments that are being made and to the nature of the consultation. I will consider all the information that is available and all representations that have been made to me before I come to a view. I have already started to look at the issues in detail and I will continue to examine them over the coming months. Like Sandra White and other members, I visited Yorkhill in the summer and I have spoken to many clinicians and members of the public about the proposals. However, as I said at question time recently, I have been struck by the way in which, more than in most reorganisations, senior clinicians are totally divided on the issue and are expressing contrary views. That is a particular challenge to us all in addressing the matter.

I will refer to two specific points before moving on to talk about maternity services more generally. First, Carolyn Leckie raised a point about ECMO. That is funded by the national services division and, therefore, will continue to be provided in Glasgow. It is something for which we are responsible.

The minister may not be aware of it, but the point that Carolyn Leckie was making was that the consultant who runs that service has already advised the national services division that he would be unhappy to do so if he did not have a link with the Queen Mother's hospital.

That is certainly one of the many points that I can look at. I wanted to establish the principle that we, not Greater Glasgow NHS Board, control that service.

Several members—including Murray Tosh, Robert Brown, Jackie Baillie and Tommy Sheridan—raised the issue of planning services in a regional context. As members know, and as Jackie Baillie reminded us, I asked NHS Argyll and Clyde and Glasgow to undertake further work in that area and for that work to be taken forward alongside the review that is currently being undertaken by Glasgow. I have asked for a report of that work to be submitted to me by April 2004 and can assure Tommy Sheridan that Glasgow will take no decisions until that work has been completed.

I need to put the issue in the more general context of maternity services in Scotland. The fact that the birth rate in Scotland is falling is not irrelevant, although I know that people can draw different conclusions from it. We should remind ourselves that, in the decade between 1991 and 2001, there was a 22 per cent fall in the birth rate.

Another important general point was made by Johann Lamont when she emphasised the importance of flexible local antenatal and postnatal care. Whatever the outcome in Glasgow, the reality is that more maternity care will be delivered in local communities. That partly answers Paul Martin's question about how services will improve.

Murray Tosh said that there had been no national debate and that there was no national strategy. I have to remind him and others that, in 2001, the Scottish Executive published a framework for maternity services in Scotland and that, in 2002, I set up the expert group on acute maternity services—EGAMS—which was a short-life working group of professionals and other stakeholders that considered how the principles of the maternity services framework should be applied to care during childbirth.

The point that I was making is that the public are completely unaware of and uninvolved in that and feel utterly left out of the process. The minister has a particularly serious job to do in the areas that are the subject of the reviews if he is to ensure that credibility is retained in the process of public consultation and involvement.

I fully accept that we can do a better job of communicating some of the general issues around maternity services and I assure Mr Tosh that we shall do so. Indeed, that is what I am attempting to do in the closing minutes of my speech.

The EGAMS report addresses some of the issues about consultant-led units, which are at the centre of the debate for many people. The EGAMS report concluded that the current configuration of acute maternity services needs to change. Women at risk of complications in pregnancy should have consultant-led care. The falling birth rate means that some units will not care for sufficient numbers of women and babies to ensure that professional skills and experience can be maintained to an adequate level to provide the highest quality of care. In short, the specialists working in smaller maternity units simply do not get the experience that they need to maintain their skills and to provide safe, specialist care. A rationalisation of consultant-led units will ensure that women who require it will benefit from hands-on care from specialist staff. It will also ensure that staff in training are well supervised and supported.

The report also concluded that we need to realise the full potential of midwives to ensure continuity of care and the provision of childbirth services at as local a level as possible. The midwife's role should be maximised to lead management of pregnancy and childbirth for low-risk women; steps in that direction should include establishing midwife-led units. I was pleased to hear Jackie Baillie welcome the creation of a midwife-led unit at the Vale of Leven hospital.

According to the Greater Glasgow NHS Board, the EGAMS report says that there needs to be an on-site adult intensive therapy unit whereas, in fact, the EGAMS report says that the units such as the one at the Queen Mother's hospital should "have access to" adult ITU facilities. Does the minister agree, therefore, that Glasgow has been misleading people quite badly in that regard?

That point goes to the heart of the debate, but the fact is that obstetricians in general believe that maternity services should be co-located with adult services. There is a splendid service at Yorkhill, but that model, involving only maternity and child services, is not used in any other hospital in the United Kingdom. Of course, that does not take away from the fact that Yorkhill provides an excellent service.

Following the EGAMS report, the Executive provided £150,000 to put in place three regional maternity services co-ordinators to ensure that local planning and commissioning of services take place within a regional context. That is part of our and the EGAMS report's general emphasis on regional planning.

We have provided more than £1 million for training and education in order to upskill midwives and, through a national work force planning group, we have established a process for work force planning for maternity services.

I assume that my time is more or less up, so I will conclude. Implementation of the EGAMS report will ensure that local, regional and national networks provide vehicles for the provision of high-quality maternity care throughout Scotland as part of a framework of tiered care, with clear and explicit communication and referral pathways.

As far as Glasgow is concerned, I can assure members that I will pay close attention to all the arguments that have been made today, as well as to the points that have been raised by many other people, including members of the public and clinicians, with all their diverse views on the issue. I will consider the substantive proposals that have been made and the adequacy of the consultation. There will be no rubber-stamping. The important next step is for the consultation to proceed.

Meeting closed at 18:16.